Squatting--A Femiist Posture?

[thanka2]

This week, as I am 37-weeks pregnant with my second child, the doctor I had been seeing for the past 5 months who had assured me he was informed on natural childbirth, after a long consultation over my birth plan (which worked successfully for the birth of my first child) and then making some compromises and agreeing to the birth plan, called me up and essentially told me, "I only know how to deliver babies if the woman is lying flat on her back" (and likely pumped full of drugs). I now find this doctor to be one of the most spineless professionals I have ever come across. He was aware of my birth intentions from the beginning--I made them very well known to him. But he led us on to think that he was comfortable with them and then at the last moment bailed out on us. I'm thankful that his true colors shone through before the birth, though. I consider that God's grace. My thoughts when he told me this (over the phone) were, "How can you call yourself a doctor and have no concept of how to attend a birth--except for employing one very one-dimensional (and inefficient) method?"

Then, just tonight I finally received this following book in the mail and found the excerpt below very fitting. Just goes to show--leave it to men to profoundly mess things up by trying to 'fix what isn't broken.' May we all be aware of the history of the lithotomy position (on your back) in labor.

From Ina May's Guide to Childbirth
Chapter 7 (page 226)
Move Freely, Let Gravity Work For You

Women in traditional societies all over the world almost always choose upright positions in labor. This worldwide consensus suggests that women don't choose to lie down to labor and give birth unless forces within their culture pressure them into doing so. The labor postures common to traditional women's cultures all over the world include sitting, kneeling, standing, squatting or the hands-and-knees position. Sometimes these positions involve the use of supports of various kinds: ropes for the mother to pull on, birth chairs, stakes pounded into the ground, or the embrace of a husband or female attendant. The list of benefits of upright positions in labor includes:

• better use of gravity
• maximum circulation between mother and baby (no compression caused by the baby's weight on the mother's major blood vessels)
• better alignment of the baby to pass through the pelvis
• stronger rushes [contractions]
• increased pelvic diameters when squatting or kneeling

The first recorded instance of a woman lying on her back during labor was of Louise de la Valliere, a mistress of King Louis XIV of France in 1663. The choice of position was probably not hers but her lover's. He wanted to sit behind a curtain and witness the emergence of the baby. As King, he had privileges that did not belong to other men. Previous to that time, it had been taboo for men--including babies' fathers--to be present in the birth room Less than one hundred fifty years before de la Valliere gave birth, Dr. Wert from Hamburg was burned at the stake for daring to dress in women's clothes so that he could attend a birth. (Apparently, his cross-dressing was unconvincing to the other attendants at the birth).

The prohibition against man-midwives in the birth room began to break down with the invention of forceps, which were first used in England and France. Forceps reinforced the fashion of the reclining position in labor, as this is the best position for their use. In 1668, Francois Mauriceau published a treatise on midwifery that recommended that women lie on their backs for giving birth. This recommendation was made for the benefit of the physician or man-midwie who might want to use forceps, not for the benefit of the laboring woman herself. Two hundred years later, Queen Victoria became the first woman in England to use chloroform while giving birth. This event quickly popularized the use of various forms of anesthesia for labor, which led to a significant number of influential women lying down during labor. By the end of the nineteenth century, birth chairs were rarely used any longer. "Fashionable" ladies expected to lie down to have their babies. Giving birth in a squatting position came to be considered low-class--far from "ladylike." Given this history, it is not an exaggeration to call the supine position an invention of the industrial revolution. It is a male-derived position--one invented for the convenience of the birth attendant. As women often realize when they are caught in the "stranded beetle" position, it can be very hard work to work against gravity when pushing a baby out.

In my search for some birthing clipart I came across this.

 

[thanka2]

I think the link for the birthing clipart isn't quite working but this link should.

 

[Papaya]

Hi Thanka,

Really sorry to hear about your doctor letting you down in this way. Perhaps you could share his name as a warning to others. I too used the squatting position and could not imgagine using any other position in another labour.

I too was inspired by images and stories of other women's births, many of them the very same ones that you posted over the last few months. Here is one that takes things a step further. http://freebirthing.org/ Clio's birthing shown here would put your doctor to shame. You sound very knowledgeable, experienced and determined. No one can force you into doing something if don't want.

Wishing you a very peaceful, healthy and fulfilling delivery.

 

[thanka2]

I think the link for the birthing clipart isn't quite working but this link should.

So, that link is a bit fickle and I'm just going to post the image below here.

 

[thanka2]

Hi Thanka,

Really sorry to hear about your doctor letting you down in this way. Perhaps you could share his name as a warning to others. I too used the squatting position and could not imgagine using any other position in another labour.

I too was inspired by images and stories of other women's births, many of them the very same ones that you posted over the last few months. Here is one that takes things a step further. http://freebirthing.org/ Clio's birthing shown here would put your doctor to shame. You sound very knowledgeable, experienced and determined. No one can force you into doing something if don't want.

Wishing you a very peaceful, healthy and fulfilling delivery.

Thanks, Papaya. Really, what happened with that doctor is for the better. Honestly, I view childbirth as a sacred and important part of life and anyone who attends the birth of my children, even as a physician or nurse, is invited as a guest (whether they realize it or not). So, I am glad that this doctor uninvited himself. I certainly don't need that type of person at such an important event.

When I was in labor with my son, I tried a variety of positions but because of my prolonged labor (in total 43+ hours when he was born) by the time I was actually pushing my son out, I ended up in an adjusted lithotomy position (not quite lying flat on my back but...). At the time this was my choice as I was literally shaking all over from exhaustion (my muscles in my legs were going through spasm involuntarily) and was having difficulty supporting my own weight. However, there was a price to be paid for being in this position as I tore quite a lot--the lithotomy position is known for producing lots of episiotomies and tears. So, in the end, that was the position I was in but if I had to choose I would never give birth in that position--it's uncomfortable, awkward and inefficient. I guess it's probably your only choice, though if you've got a strong epidural going on or you're tethered to the bed by a baby monitor and IV. And as can be seen by the above excerpt and also the doctor's comments, lithotomy position is most convenient for the doctor but does absolutely nothing to facilitate birth. It's a nice position for doctors who are all too happy to play with their "toys" (forceps and vacuum extractor--both of which usually cause at least some injury to the newborn baby and also the mother).

Yeah, I find it shameful that the medical profession when it comes to birth in HK is totally run as a business/assembly line--especially when most of the rest of the world has caught on to the more advanced way of doing things.

Over the past 4 months I have researched and researched and read and really been inspired. I do feel more knowledgeable this time around with this birth--and with my first birth I had done 3-months-worth of natural childbirth classes and also was extremely prepared--what I've found is that there is so many wonderful things to know about childbirth--I'm just scratching the surface, I believe. I sure do hope that it's true that no one can force me to do something I don't want. The problem is the confrontation that seems to have to take place to really stand for what you want in the hospital--shouldn't be necessary and is totally counter-productive physiologically to labor and birth.

Well, it won't be long now....baby is due in 2 weeks but it could be much, much sooner than that!

Again, thanks for your support and kind words--not many like you in HK, I think. All the best to you!

 

[Gracey]

So, are you going to try to find another doctor at the last minute? Where are you delivering? Good luck to you.

 

[thanka2]

So, are you going to try to find another doctor at the last minute? Where are you delivering? Good luck to you.

No, not going to try to find another doctor--there isn't a doctor in HK that would take me on at this point--38 weeks pregnant--basically because it would be nearly impossible to register me in another hospital and I'm definitely not going to give birth in Tsuen Wan Adventist (no way! no how!)

Thankfully, I had registered early on at the public hospital in Chai Wan (Pamela Youde Nethersole Eastern Hospital--boy is that a mouthful to say!) I've done some of my checkups there and they have all my files. But, the issue is that our house is about as far away from Chai Wan as it gets and we don't have a car. We think there is a friend nearby with a car who can drive us (she's nervous about taking me that far while I'm in labor, though) and we have a taxi company that says they can take us from here to there (it's very hard to get a taxi where we live--and the taxi drivers are known to be really rude and reckless around these parts). My concern with the taxi, knowing how the taxi drivers around here are, is that if we call one and they realize I'm in labor they may very well refuse to take me. If I call the ambulance, under the new ambulance rules, they will take me to the nearest hospital in Tuen Mun which is exactly what I want to avoid as I had a really nasty experience there when I was hospitalized for suspected ectopic pregnancy earlier last year. If you've been reading in the South China Morning Post over this week, the Tuen Mun hospital is really suffering--25% of their doctors have quit in the past year because the working conditions are so poor--and it really shows. Anyway...

So, no matter what, this birth is going to be interesting. I think everything will go well and I'm at peace. Nothing to fear but fear itself.

 

[Gracey]

I just visited the maternity ward at Baptist (which I wrote about in a separate post). And I asked the nurses about standing / walking around during labor and they were like "women don't do that." Sigh.
It's good that you're at peace. I'm sure it will all be fine. Best of luck to you!

 

[thanka2]

I just visited the maternity ward at Baptist (which I wrote about in a separate post). And I asked the nurses about standing / walking around during labor and they were like "women don't do that." Sigh.
It's good that you're at peace. I'm sure it will all be fine. Best of luck to you!

Sad, but doesn't surprise me at all. The mentality toward birth in Hong Kong, across the board, is what it is. Until there is some sort of advancement in thinking here (beyond 1950) things won't change. Unfortunately, the people with the greatest potential to be agents of change (midwives educated to do the work of a midwife--not just work as an obstetric nurse) aren't even really a part of the system. Sure, we've got Annerly Midwives here but they aren't a functioning part of the decision making in any of the hospitals in HK--just on the outside fringes serving private clients and helping them to cope with the burdensome constraints of the hospitals here. Anywhere, any time a change truly happens in the maternity system (for the better) it's usually a very dedicated group of midwives who get it done and prove it's value. Doctors just want you in and out so they can get to their golf date.